| NPI | 1407083132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD452256) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD452256) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2023-11-20 |